The Clinical Evaluation for Diagnosing Obstructive Airways Disease in High-Risk Patients

Badgett, Robert G.; Tanaka, David J.; Hunt, Debra K.; Jelley, Martina J.; Feinberg, Lawrence E.; Steiner, John F.; Petty, Thomas L.

doi:10.1378/chest.106.5.1427

Cited by 35 publications

(20 citation statements)

References 23 publications

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“…Based on the literature, 11 and clinical reasoning, the following symptoms and signs with potential value to detect early COPD were evaluated: age, 12 16 allergy for pollen, house dust mites, cats, or dogs, 6 diminished breath sounds, 17 and wheezing on auscultation.…”

Section: Resultsmentioning

confidence: 99%

“…Cough, age, sex, dyspnoea, pack-years of smoking, wheezing (auscultated and reported), and consultation for wheezing or cough were associated with COPD in primary 6,12,15 and secondary care 13,17,27,28 studies, and diminished breath sounds in secondary care studies. 14,17,29 Some reported diagnostic items were not included in the present analysis, including forced expiratory time, 27,28,30 laryngeal height, 13 peak flow, 17,27 and subxyphoid apical impulse, 4 because they are not incorporated in standard physical examination. Moreover, some features of COPD were not assessed because they were considered unlikely in early COPD, such as barrel chest and accessory muscle use.…”

Section: Comparison With Existing Literaturementioning

confidence: 90%

See 1 more Smart Citation

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Broekhuizen

Sachs²,

Verheij³

et al. 2012

Br J Gen Pract

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Section: Resultsmentioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 90%

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Broekhuizen

Sachs²,

Verheij³

et al. 2012

Br J Gen Pract

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“…41 A combination of medical history/risk for COPD in combination with peak flow has successfully been used as a screening mechanism to identify those with COPD in the general population. [42][43][44] This study aimed to explore the predictive value of a screening strategy using a brief history and peak expiratory flow measurement for the determination of pulmonary function abnormalities and the diagnosis of COPD in patients infected with HIV. We also sought to identify HIV-related factors that could influence pulmonary function.…”

mentioning

confidence: 99%

Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

Shirley¹,

Kaner

Glesby

2015

AIDS Patient Care and STDs

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Increased smoking and a detrimental response to tobacco smoke in the lungs of HIV/AIDS patients result in an increased risk for COPD. We aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. Subjects at least 35 years of age at an HIV clinic in New York City completed a COPD screening questionnaire and peak flow measurement. Those with abnormal results and a random one-third of normal screens had spirometry. 235 individuals were included and 89 completed spirometry. Eleven (12%) had undiagnosed airway obstruction and 5 had COPD. A combination of a positive questionnaire and abnormal peak flow yielded a sensitivity of 20% (specificity 93%) for detection of COPD. Peak flow alone had a sensitivity of 80% (specificity 80%). Abnormal peak flow was associated with an AIDS diagnosis ( p = 0.04), lower nadir ( p = 0.001), and current CD4 counts ( p = 0.001). Nadir CD4 remained associated in multivariate analysis (p = 0.05). Decreased FEV1 ( < 80% predicted) was associated with lower CD4 count nadir ( p = 0.04) and detectable current HIV viral load ( p = 0.01) in multivariate analysis. Questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.

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“…Therefore, the physician's estimation in the study may have been more accurate than the initial diagnostic assessment of COPD in daily practice. Comparison with existing literature Others have studied the diagnostic value of clinical assessment for COPD, [13][14][15][16][17] and reported sensitivities ranging from 50% to 64% and specificities from 64% to 93%. Considering an estimated probability of <20% as 'COPD excluded' in the present study, would result in a sensitivity of 82% and a specificity of 47%.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

Broekhuizen

Sachs²,

Janssen³

et al. 2011

Br J Gen Pract

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BackgroundNumerous decision aids have been developed recently, but the value they add above that of the initial clinical assessment is not well known. AimTo quantify whether a formal decision aid for chronic obstructive pulmonary disease (COPD) adds diagnostic information, above the physician's clinical assessment. Design and settingSubanalysis of a diagnostic study in Dutch primary care. MethodSixty-five primary care physicians included 357 patients who attended for persistent cough and were not known to have COPD. The physicians estimated the probability of COPD after short history taking and physical examination. After this, the presence or absence of COPD was determined using results of extensive diagnostic work-up. The extent to which an 8-item decision aid for COPD, which included only symptoms and signs, added diagnostic value above the physician's estimation was quantified by the increase of the area under the receiver operating characteristic curve (ROC area), and the improvement in diagnostic risk classification across two classes: 'low probability of COPD' (<20%) and 'possible COPD' (≥20%). ResultsOne hundred and four patients (29%) had COPD. Adding the decision aid to the clinical assessment increased the ROC area from 0.75 (95% confidence interval [CI] = 0.70 to 0.81) to 0.84 (95% CI = 0.80 to 0.89) (P<0.005), and improved the diagnostic risk classification of the patients, such that 35 fewer patients needed spirometry testing and eight fewer COPD cases were missed. ConclusionA short decision aid for COPD added diagnostic value to the physician's clinical assessment.

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The Clinical Evaluation for Diagnosing Obstructive Airways Disease in High-Risk Patients

Cited by 35 publications

References 23 publications

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

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